Squamous Cell Carcinoma of the Bulbar Urethra

Abstract

A 49-year-old man with a history of balanitis xerotica obliterans and meatal stricture treated with circumcision and meatoplasty 4 years before presented with a recurrent urinary tract infection. Urethroscopy revealed a lesion in the bulbar urethra, which was confirmed to be a squamous cell carcinoma (SCC) with histology. Magnetic resonance imaging (MRI) confirmed a bulky tumor that emanated from the bulb of the penis, abutted the anorectal junction, and extended to involve the corpora cavernosa, the urogenital diaphragm, the apex of the prostate, and the levator ani. [ 18 F]fluorodeoxyglucose positron emission tomography (PET) showed an avid primary lesion with biliateral inguinal lymph node avidity. The multidisciplinary consensus was treatment with radical chemoradiotherapy to obtain local control and treat potential micrometastatic disease followed by radical surgery with curative intent and to gain local control if restaging imaging showed no metastatic disease. The patient received six cycles of cisplatin and 60 Gy of radiotherapy in 30 fractions over 38 days. Restaging MRI 6 weeks after completion of chemoradiotherapy showed a decrease in size of the tumor with central necrosis and a new lesion in the distal penis. PET showed a partial metabolic response in the primary tumor (Figs 1A, PET at diagnosis and 1B, 6 weeks after chemoradiotherapy), persisting mild uptake in a single inguinal node, and new mild uptake in an external iliac node, which was thought to be reactive and was subsequently confirmed by using fine-needle aspiration. Because of the good response to chemoradiotherapy, the consensus was to repeat imaging in 6 weeks to assess a possible ongoing response to chemoradiotherapy before radical surgery. Six weeks later, PET showed interval progression (Figs 2A, PET 6 weeks after chemoradiotherapy and 2B, 12 weeks after chemoradiotherapy), with more intense uptake in the primary tumor, that

Radical Chemoradiotherapy for Urethral Squamous Cell Carcinoma: Two Case Reports and a Review of the Literature

“…Table 1 illustrates a summary of the published literature from PubMed spanning several decades and the modalities used [10–19]. …”

Lichen Sclerosus Accompanied by Urethral Squamous Cell Carcinoma: A Retrospective Study From a Urethral Referral Center

“…However, the patients with bulbar USCC, bulbomembranous USCC, and entire USCC present a higher stage in this study and all cases died of distant metastasis despite treatment with surgery, chemotherapy, and radiation therapy. Similarly, Memon ( Memon et al, 2011 ) have reported a case of LS accompanied by bulbar USCC presented with a recurrent urinary tract infection. The tumor abutted the anterior rectal wall and infiltrated through the levator ani into the perineum.…”

“…Many studies have implied that LS is a premalignant condition and an independent risk factor for pSCC with a reported lag time from onset of LS to diagnosis of malignancy of 18 years ( Fistarol & Itin, 2013 ; Potts et al, 2016 ). While this has been definitively shown in the female population with LS, most of these reports in men tend to be anecdotal and retrospective ( Memon et al, 2011 ; Peng, Guo, Jin, Wang, & Sa, 2018 ). The reported risk of pSCC in male patients with genital LS is estimated at between 2% and 12.5% ( Bunker & Shim, 2015 ).…”

Pathologic Complete Response After Chemoradiation of a Massive Primary Urethral Carcinoma

“…Ta to T2 tumors had higher rates of freedom from recurrence (89%) compared with T3 to T4 tumors (42%) 14 Table 1 summarizes the published clinical experience 15, 16, 17, 18, 19, 20, 21, 22, 23. Serrano et al emphasized that, if patients are given an option of organ preservation with CRT, they are extremely likely to opt for this over surgery because of the reduced morbidity 5 .…”